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June 1994

A Potentially Serious Adverse Reaction Between Sodium Fluorescein and Promethazine Solutions: Flush the Cannula Before Injecting

Author Affiliations

Sydney, Australia

Arch Ophthalmol. 1994;112(6):734-735. doi:10.1001/archopht.1994.01090180032010

Side effects following the intravenous administration of sodium fluorescein are relatively common, with an incidence of about 5%.1 They are usually mild and restricted to transient nausea and vomiting. More serious adverse reactions are well documented, but uncommon, with an estimated prevalence rate of 0.7%.1 An allergic reaction to fluorescein is the most common severe response, and in the majority of patients consists of acute urticaria and wheal formation with anaphylaxis occurring rarely. Antihistamine drugs, such as promethazine hydrochloride (Phenergan), are widely recommended to treat nonanaphylactic acute adverse reactions and are also commonly used as prophylactic medication in patients with a history of nausea or vomiting after undergoing fluorescein angiography.2

We have noted a drug incompatibility when promethazine and fluorescein are mixed together in a syringe, with resultant macroscopic precipitate formation (Figure 1). This drug precipitation reaction has been recognized in the pharmaceutical literature but, to our

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